CMS System Edits Reduced Medicare Overpayments to Hospitals
Medicare overpayments totaled $39.3 million between September 2016 and December 2021, but most of those improper payments occurred before CMS corrected its system edits error in May 2019.
CMS system edits helped reduce Medicare overpayments to acute care hospitals for outpatient services provided to beneficiaries who were inpatients of other facilities, a report from the Office of Inspector General (OIG) found.
Through a previous audit, OIG found that Medicare inappropriately paid acute care hospitals $51.6 million for services provided between January 2013 and August 2016. The payments were for outpatient services provided to individuals who were inpatients of long-term care hospitals (LTCHs), inpatient rehabilitation facilities (IRFs), inpatient psychiatric facilities (IPFs), and critical access hospitals (CAHs).
The overpayments occurred because system edits were not working correctly, according to OIG.
